Endometriosis fertility index: the new, validated endometriosis staging system
Open accessAbstract
Objective To develop a clinical tool that predicts pregnancy rates (PRs) in patients with surgically documented endometriosis who attempt non-IVF conception.Design Prospective data collection on 579 patients and comprehensive statistical analysis to derive a new staging system--the endometriosis fertility index (EFI)--from data rather than a priori assumptions, followed by testing the EFI prospectively on 222 additional patients for correlation of predicted and actual outcomes.Setting Private reproductive endocrinology practice.Patient(s) A total of 801 consecutively diagnosed and treated infertile patients with endometriosis.Intervention(s) Surgical diagnosis and treatment followed by non-IVF fertility management.Main outcome measure(s) The EFI and life table PRs.Result(s) A statistically significant variable used to create the EFI was the least function score (i.e., the sum of those scores determined intraoperatively after surgical intervention that describe the function of the tube, fimbria, and ovary on both sides). Sensitivity analysis showed that the EFI varies little, even with variation in the assignment of functional scores, and predicted PRs.Conclusion(s) The EFI is a simple, robust, and validated clinical tool that predicts PRs after endometriosis surgical staging. Its use provides reassurance to those patients with good prognoses and avoids wasted time and treatment for those with poor prognoses.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The EFI is a simple, robust, and validated clinical tool that provides reassurance to those patients with good prognoses and avoids wasting time and treatment for those with poor prognoses.
“The EFI is a simple, robust, and validated clinical tool that provides reassurance to those patients with good prognoses and avoids wasting time and treatment for those with poor prognoses.”
From Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France (2013) · cites this paper as [27]
The endometriosis fertility index (EFI) is a clinical tool that predicts pregnancy rates in patients with surgically documented endometriosis who attempt non-in vitro fertilization conception.
“The endometriosis fertility index (EFI) is a clinical tool that predicts pregnancy rates in patients with surgically documented endometriosis who attempt non-in vitro fertilization conception.27”
From Defining Future Directions for Endometriosis Research: Workshop Report From the 2011 World Congress of Endometriosis in Montpellier, France (2013) · cites this paper as [27]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Revised American Fertility Society Classification of Endometriosis: 1985
(1985) · Fertility and Sterility · doi:10.1016/s0015-0282(16)48430-x · Cited by 1,803 · see citing works
PERFORATING HEMORRHAGIC (CHOCOLATE) CYSTS OF THE OVARY
SAMPSON, J. A. (1921) · Archives of Surgery · doi:10.1001/archsurg.1921.01110080003001 · Cited by 492 · see citing works
Classification of Endometriosis
The American Fertility Society (1979) · Fertility and Sterility · doi:10.1016/s0015-0282(16)44409-2 · Cited by 305 · see citing works
Goldfarb, A. F. (1970) · Fertility and Sterility · doi:10.1016/s0015-0282(16)37275-2 · Cited by 279 · see citing works
A proposed classification of pelvic endometriosis.
Acosta, A. A., Buttram, V. C., Pk, B., Malinak, L. R., Rr, F., & Jd, V. (1973) · PubMed · Cited by 232 · see citing works
Subtle appearance of pelvic endometriosis
Stripling, M. C., Martin, D. C., Chatman, D. L., Zwaag, R. V., & Poston, W. M. (1988) · Fertility and Sterility · doi:10.1016/s0015-0282(16)59767-2 · Cited by 167 · see citing works
Evolution of the revised American Fertility Society classification of endometriosis.
Buttram, V. (1985) · Fertility and Sterility · doi:10.1016/s0015-0282(16)48429-3 · Cited by 155 · see citing works
6 Classification of endometriosis
Canis, M. J., de Jolinières, J. B., Wattiez, A., Pouly, J. L., Mage, G., MANHES, H., & Bruhat, M. A. (1993) · Baillière s Clinical Obstetrics and Gynaecology · doi:10.1016/s0950-3552(05)80462-6 · Cited by 119 · see citing works
The revised American Fertility Society classification of endometriosis: reproducibility of scoring
Rock, J. A., & Zoladex Endometriosis Study Group (1995) · Fertility and Sterility · doi:10.1016/s0015-0282(16)57556-6 · Cited by 97 · see citing works
Laparoscopic endometriosis treatment: Is it better?
Adamson, G. D., Hurd, S. J., Pasta, D. J., & Rodriguez, B. D. (1993) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(93)90246-s · Cited by 93 · see citing works
Self-citationThe reproducibility of the revised American Fertility Society classification of endometriosis
Hornstein, M. D., Gleason, R. E., Orav, E. J., Haas, S. T., Friedman, A. J., Rein, M. S., Hill, J. A., & Barbieri, R. L. (1993) · Fertility and Sterility · doi:10.1016/s0015-0282(16)55921-4 · Cited by 92 · see citing works
Laparoscopic endometriosis treatment: is it better?
Adamson, G. D., Hurd, S. J., Pasta, D. J., & Rodriguez, B. D. (1993) · Fertility and Sterility · doi:10.1016/s0015-0282(16)55611-8 · Cited by 87 · see citing works
Self-citationSuggested Classification for Endometriosis: Relationship to Infertility
Kistner, R. W., Siegler, A. M., & Behrman, S. J. (1977) · Fertility and Sterility · doi:10.1016/s0015-0282(16)42807-4 · Cited by 80 · see citing works
Comparison of CO2 laser laparoscopy with laparotomy for treatment of endometriomata
Adamson, G. D., Subak, L. L., Pasta, D. J., et al. (1992) · Fertility and Sterility · doi:10.1016/s0015-0282(16)55010-9 · Cited by 78 · see citing works
Self-citationWiegerinck, M. A. H. M., van Dop, P. A., & Brosens, I. A. (1993) · Fertility and Sterility · doi:10.1016/s0015-0282(16)56161-5 · Cited by 73 · see citing works
Reliability of the visual diagnosis of ovarian endometriosis
Vercellini, P., Vendola, N., Bocciolone, L., Rognoni, M. T., Carinelli, S. G., & Candiani, G. B. (1991) · Fertility and Sterility · doi:10.1016/s0015-0282(16)54744-x · Cited by 68 · see citing works
An Expanded Classification of Endometriosis
Buttram, V. C. (1978) · Fertility and Sterility · doi:10.1016/s0015-0282(16)43467-9 · Cited by 46 · see citing works
Canis, M. J., Pouly, J. L., Wattiez, A., et al. (1992) · Fertility and Sterility · doi:10.1016/s0015-0282(16)54924-3 · Cited by 42 · see citing works
Laparoscopic ovarian puncture for correct staging of endometriosis
Candiani, G. B., Vercellini, P., & Fedele, L. (1990) · Fertility and Sterility · doi:10.1016/s0015-0282(16)53573-0 · Cited by 39 · see citing works
Guzick, D. S., Bross, D. S., & Rock, J. A. (1982) · Fertility and Sterility · doi:10.1016/s0015-0282(16)46454-x · Cited by 38 · see citing works
Endometriosis: studies of a method for the design of a surgical staging system
Adamson, G. D., Frison, L., & Lamb, E. J. (1982) · Fertility and Sterility · doi:10.1016/s0015-0282(16)46690-2 · Cited by 29 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Zondervan, K. T., Becker, C. M., Koga, K., Missmer, S. A., Taylor, R. N., & Viganò, P. (2018) · Nature Reviews Disease Primers · doi:10.1038/s41572-018-0008-5 · Cited by 1,257 · see citing works
Pathophysiology, diagnosis, and management of endometriosis
Horne, A. W., & Missmer, S. A. (2022) · BMJ · doi:10.1136/bmj-2022-070750 · Cited by 661 · see citing works
World Endometriosis Society consensus on the classification of endometriosis
Johnson, N. P., Hummelshoj, L., Adamson, G. D., Keckstein, J., Taylor, H. S., Abrao, M. S., Bush, D., Kiesel, L., Tamimi, R., Sharpe-Timms, K. L., et al. (2017) · Human Reproduction · doi:10.1093/humrep/dew293 · Cited by 664 · see citing works
Self-citationConsensus on current management of endometriosis
Johnson, N. P., Hummelshoj, L., for the World Endometriosis Society Montpellier Consortium, Abrao, M. S., Adamson, G. D., Allaire, C., Amelung, V., Andersson, E., Becker, C., Birna Árdal, K. B., et al. (2013) · Human Reproduction · doi:10.1093/humrep/det050 · Cited by 558 · see citing works
Self-citationChronic pelvic pain and endometriosis: translational evidence of the relationship and implications
Stratton, P., & Berkley, K. J. (2011) · Human Reproduction Update · doi:10.1093/humupd/dmq050 · Cited by 442 · see citing works
Endometriosis‐associated infertility: aspects of pathophysiological mechanisms and treatment options
Tanbo, T., & Fedorcsak, P. (2017) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13082 · Cited by 432 · see citing works
Becker, C. M., Laufer, M. R., Stratton, P., Hummelshoj, L., Missmer, S. A., Zondervan, K. T., Adamson, G. D., Adamson, G. D., Allaire, C., Anchan, R., et al. (2014) · Fertility and Sterility · doi:10.1016/j.fertnstert.2014.07.709 · Cited by 206 · see citing works
Self-citationThe rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses
HAAS, D., SHEBL, O., SHAMIYEH, A., & OPPELT, P. (2013) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.12026 · Cited by 204 · see citing works
Pain typology and incident endometriosis
Schliep, K. C., Mumford, S. L., Peterson, C. M., Chen, Z., Johnstone, E. B., Sharp, H. T., Stanford, J. B., Hammoud, A. O., Sun, L., & Buck Louis, G. M. (2015) · Human Reproduction · doi:10.1093/humrep/dev147 · Cited by 164 · see citing works
Rogers, P. A. W., D’Hooghe, T. M., Fazleabas, A., Giudice, L. C., Montgomery, G. W., Petraglia, F., & Taylor, R. N. (2013) · Reproductive Sciences · doi:10.1177/1933719113477495 · Cited by 154 · see citing works
Endometriosis and infertility: Insights into the causal link and management strategies
Tomassetti, C., & D'Hooghe, T. (2018) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2018.06.002 · Cited by 132 · see citing works
Endometriosis classification: an update
Adamson, G. D. (2011) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/gco.0b013e328348a3ba · Cited by 119 · see citing works
Self-citationBowel endometriosis: Colorectal surgeon’s perspective in a multidisciplinary surgical team
Wolthuis, A. M. (2014) · World Journal of Gastroenterology · doi:10.3748/wjg.v20.i42.15616 · Cited by 110 · see citing works
Colorectal endometriosis and fertility
Daraï, E., Cohen, J., & Ballester, M. (2017) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2016.05.024 · Cited by 100 · see citing works
Sofo, V., Götte, M., Laganà, A. S., Salmeri, F. M., Triolo, O., Sturlese, E., Retto, G., Alfa, M., Granese, R., & Abrão, M. S. (2015) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-015-3739-5 · Cited by 88 · see citing works
Montanari, E., Dauser, B., Keckstein, J., Kirchner, E., Nemeth, Z., & Hudelist, G. (2019) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2019.06.006 · Cited by 72 · see citing works
New biomarkers in endometriosis
(2019) · Advances in clinical chemistry · doi:10.1016/bs.acc.2018.12.002 · Cited by 72 · see citing works
The known, the unknown and the future of the pathophysiology of endometriosis
Ochoa Bernal, M. A., & Fazleabas, A. T. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25115815 · Cited by 59 · see citing works
“However, if this condition is found, it is not taken into consideration [136].”
BackgroundMethodInfluentialGenetic burden associated with varying degrees of disease severity in endometriosis
Sapkota, Y., Attia, J., Gordon, S. D., Henders, A. K., Holliday, E. G., Rahmioglu, N., MacGregor, S., Martin, N. G., McEvoy, M., Morris, A. P., et al. (2015) · Molecular Human Reproduction · doi:10.1093/molehr/gav021 · Cited by 43 · see citing works
Kolanska, K., Cohen, J., Bendifallah, S., Selleret, L., Antoine, J.-M., Chabbert-Buffet, N., Darai, E., & d’Argent, E.-M. (2017) · Journal of Gynecology Obstetrics and Human Reproduction · doi:10.1016/j.jogoh.2017.09.007 · Cited by 42 · see citing works
Interrater and intrarater reliability in the diagnosis and staging of endometriosis
Schliep, K. C., Stanford, J. B., Chen, Z., Zhang, B., Dorais, J. K., Boiman Johnstone, E., Hammoud, A. O., Varner, M. W., Louis, G. M. B., & Peterson, C. M. (2012) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e31825bc6cf · Cited by 33 · see citing works
Nezhat, C. R., Oskotsky, T. T., Robinson, J. F., Fisher, S. J., Tsuei, A., Liu, B., Irwin, J. C., Gaudilliere, B., Sirota, M., Stevenson, D. K., et al. (2025) · npj Women s Health · doi:10.1038/s44294-024-00052-w · Cited by 25 · see citing works
Effects of localization of uterine adenomyosis on clinical features and pregnancy outcome
Shi, J., Wu, Y., Li, X., Gu, Z., Zhang, C., Yan, H., Dai, Y., & Leng, J. (2023) · Scientific Reports · doi:10.1038/s41598-023-40816-z · Cited by 20 · see citing works
Etrusco, A., Chiantera, V., Serra, P., Stabile, G., Margioula-Siarkou, C., Della Corte, L., Giampaolino, P., Török, P., Baldini, G. M., Ghezzi, F., et al. (2024) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2024.102524 · Cited by 8 · see citing works
- Authors
- Adamson, G. D., & Pasta, D. J.
- Corresponding author
- Adamson, G. David
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2010-10
- Volume
- 94
- Issue
- 5
- Pages
- 1609-1615
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2135591988
- Cited by
- 483
- References
- 21
- Citations by year
- 2026: 40 · 2025: 41 · 2024: 46 · 2023: 28 · 2022: 60 · 2021: 37 · 2020: 38 · 2019: 23 · 2018: 28 · 2017: 30 · 2016: 18 · 2015: 25 · 2014: 16 · 2013: 15 · 2012: 15
- FWCI
- 14.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Funders
- EMD Serono
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- Endometriosis Fertility Index, endometriosis staging, endometriosis-associated infertility, pregnancy rate prediction, surgical staging, ovarian function, fallopian tube function, prognostic tools
- MeSH terms
- Adolescent, Adult, Endometriosis, Endometrium, Female, Humans, Infertility, Female, Predictive Value of Tests, Pregnancy, Prognosis, Prospective Studies, Retrospective Studies, Sensitivity and Specificity, Severity of Illness Index, Uterine Diseases, Proportional Hazards Models, Pregnancy Rate, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
